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PubMedDate not supplied

The endoscopically controlled osteotome sinus floor elevation: a preliminary prospective study.

PURPOSE: It was the aim of the present prospective study to quantify the gain in height of implant sites by endoscopically controlled osteotome sinus floor elevations (ECOSFE) with simultaneous implant placement and to report the number of sinus membrane perforations. MATERIALS AND METHODS: From October 1999 to December 2000, of 92 sinus floor elevations, 18 were carried out endoscopically controlled with an osteotome technique. As augmentation material, beta-tricalcium phosphate (beta-TCP) or autogenous bone was used; 22 implants were placed. RESULTS: The residual height of the alveolar crest in the posterior maxilla was 6.8 +/- 1.6 mm on average. The implant lengths ranged from 10 to 16 mm (mean implant length 12.2 +/- 1.4 mm). They were significantly larger than the residual height of the alveolar crests (P < .0005). Elevation of the sinus floor with an osteotome had to be supported by conventional sinus floor elevation instruments after a mean elevation of 3.0 +/- 0.8 mm to prevent perforation of the sinus membrane. However, 1 perforation occurred, which was repaired with a periosteal patch. At stage 2 surgery, 2 implants were removed because of mobility. Endoscopic control revealed one case in which beta-TCP could be found within the sinus; another case showed areas of polypoid mucosa on the sinus floor. DISCUSSION: With the ECOSFE, perforations of the sinus membrane can be visualized; however, they cannot be avoided. Although this technique is less invasive than the lateral window technique, it cannot be recommended as a standard procedure in the posterior maxilla because of the large amount of additional equipment needed and the technically demanding procedure. CONCLUSION: The use of the ECOSFE should be confined to scientific trials.

Adult↗
PubMedDate not supplied

Rehabilitation of patients with congenital unrepaired cleft palate defects using free iliac crest bone grafts and dental implants.

PURPOSE: To rehabilitate the mastication and speech of edentulous congenital cleft lip and palate patients with the use of endosseous implants in conjunction with bone augmentation. MATERIALS AND METHODS: Between 1992 and 1999, 6 partially and 4 completely edentulous adult patients with complex cleft palate defects were treated. Six patients had large, unrepaired defects of the hard and soft palate, whereas the other 4 had residual oronasal fistulas after failed palatoplasty and bone grafting. In 8 patients, free inlay-antral and simultaneous lateral-onlay bone grafts (3 patients) were obtained from the iliac crest, and dental implants were placed secondarily. In the other 2 patients, the implants were placed without grafting in recent extraction sites. Rigid bars with extensions over the defects were used to support obturator prostheses (n = 7), or patients were provided with fixed implant-supported prostheses (n = 3). In all, 50 cylindric, screw-type dental implants were placed and followed up for 1 to 8 years (mean, 5 years). RESULTS: Six implants were regarded as early failures and 1 was lost during the first year of loading; 1 patient lost all 5 implants. The cumulative success rate at 5 years was 85.7%. DISCUSSION AND CONCLUSION: All 9 successfully rehabilitated patients reported a remarkable functional and psychologic improvement after the treatment. The described treatment protocol also seemed to be effective for correcting velopharyngeal insufficiency in patients using an obturator prosthesis.

Adult↗
PubMed2002

Tooth structure removal associated with various preparation designs for posterior teeth.

The amount of tooth structure removed for various innovative and conventional preparation designs for fixed prosthodontics was quantified. Four Typodont resin teeth representing maxillary and mandibular premolars and molars were prepared in various abutment designs: adhesive, box (A2); adhesive, wing and groove (A3); mesioocclusal or distoocclusal inlay; mesio-occlusodistal inlay (13); mesio-occlusodistal onlay; partial crown; half crown (only molars); complete crown, 0.8-mm circumferential tapered chamfer (F1); complete crown, 1.0-mm circumferential rounded shoulder; and complete crown, 1.4-mm axial reduction facial shoulder, 0.7-mm lingual chamfer (F3). After tooth preparation (10 per group), the root was separated from the anatomic crown at the cementoenamel junction. Removal of tooth structure was measured by gravimetric analysis in a high-precision balance. Preparations A3 and F3 were assigned as abutments for metal-supported restorations, whereas all other preparations were used for all-ceramic restorations. When the mean structure removal of all teeth tested was compared, the adhesive and inlay abutments were the least invasive preparation designs, ranging from approximately 5.5% (A2) to 27.2% (13) tooth structure removal. Complete crowns required the most invasive preparations, ranging from 67.5% (F1) to 75.6% (F3) tooth structure removal. The tooth structure removal required for F3 retainers was almost 14 times greater than for an A2 preparation. Tooth structure removal was also influenced by the morphology of the tooth. The first comprehensive tooth preparation design classification system was introduced. The measurement system used in this study provides an accurate method of quantifying tooth structure removal for fixed prosthodontic preparations. The innovative preparation designs studied conserved significant amounts of tooth structure, yielding a better prognosis for the restored tooth.

Bicuspid↗
PubMed2002

Twenty years of progress in implant prosthodontics.

Prosthodontic focus on the restoration of osseointegrated dental implants has evolved dramatically in the last 20 years. Many of the original guiding principles for restoring implants have changed and/or disappeared altogether, and new ideas have taken their place. It is appropriate that this evolution be examined with a 2-fold focus. First, the art and science of prosthodontics as it relates to dental implants today is the result of very real and important lessons learned during the past 2 decades. Second, an appreciation of the history of implant prosthodontics as it relates to osseointegration gives insight into the future direction of research and clinical exploration aimed at continually improving the state of the art and, ultimately, the quality of care provided to patients. This article reviews what the authors consider the most important aspects of the evolution of osseointegrated implants. Pertinent literature was selected for citation, but the discussion does not represent a comprehensive review of the literature.

Cementation↗
PubMed2002

A meta-analysis evaluating the risk for implant failure in patients who smoke.

Failure of dental implants to achieve osseointegration is often attributed to patient baseline variables, such as smoking. This meta-analysis examines outcomes of clinical studies that monitored the performance of machined-surfaced and Osseotite, implants; the analysis also isolates the effect of smoking. The implant data for the machined-surfaced implants are derived from three prospective multicenter studies (n = 2,614) and from six prospective studies (n = 2,274) for the Osseotite implants. All implant placement surgeries followed a two-stage surgical approach with an unloaded healing period of 4 to 6 months. An evaluation of the data sets (i.e., smokers vs nonsmokers) was first performed to determine the existence of imbalance in baseline variables, including patient demographics, bone quality, location, dimensions, and types of prostheses. Analysis of the distributions of these baseline variables showed similar proportionalities and therefore qualified the data sets for comparison of the cumulative success rates (CSR) of the implants on the basis of smoking. For the 2,117 nonsmoking, machined-surfaced implants, the 3-year CSR is 92.8%; for the 492 implants in the smoking group, the CSR is 93.5%. The 3-year CSR for 1,877 nonsmoking Osseotite implants is 98.4%; for the 397 smoking implants it is 98.7%. No difference is observed between the smoking groups and the nonsmoking groups in these patient populations. There is, however, a clinically relevant difference observed between the two implant types.

Clinical Trials as Topic↗
PubMedDate not supplied

Influence of implant geometry and surface characteristics on progressive osseointegration.

PURPOSE: Although no currently available technique for the measurement of osseointegration is entirely satisfactory, 3 clinical variables can be reasonably associated with the process: probing depth, micromobility, and crestal bone height. Micromobility can be quantified to some extent with the use of the Periotest, a commercially available instrument In this investigation, the influence of surface characteristics and geometry upon Periotest value (PTV) and probing depth measurements was studied. MATERIALS AND METHODS: In a multicenter trial, 120 healthy edentulous patients received 5 or 6 implants in the anterior mandible and were followed for 3 years. A total of 634 implants were placed. Every patient received at least 1 implant of each of 3 types: threaded titanium plasma-sprayed (TPS), threaded hydroxyapatite-coated (HA), and cylindric HA-coated. A randomization schedule assured that approximately equal numbers of each type of implant were placed and that they were uniformly distributed over the arch. RESULTS: Of the 4 tested combinations of dependent and independent variables, the only statistically significant (P < .05) effect was that of coating on PTV. At 1 year after prosthetic restoration, the mean PTV for HA-coated threaded implants was -5.36 +/- 1.24, compared with -4.86 +/- 1.70 for TPS implants. This difference steadily declined in magnitude and significance, until, after 3 years, the groups were indistinguishable. DISCUSSION: This study agrees with the previous observations that HA coating tends to accelerate the initial rate of osseointegration. The absence of a difference between threaded and cylindric implants confirms that the PTV responds to micromobility near the surface, on a scale much smaller than such gross geometric features. CONCLUSION: On the basis of these results, one may conclude that HA-coated implants exhibit a more rapid decrease in micromobility than do TPS implants of identical geometry.

Coated Materials, Biocompatible↗
PubMed2000

The role of the microscope in 21st century endodontics: visions of a new frontier.

In endodontics, the microscope is indispensable. Clinicians are discovering that every facet of endodontics is better, safer, and easier. Microscopic endodontics is a new technology that emphasizes visual information, rather than tactile information. The learning curve can be fairly steep, but it is one worth climbing. Future controlled studies should document an improvement of endodontic outcomes. This is becoming more true as dentistry becomes more extensive and expensive, and needs to last longer and longer. The days of "easy cases" are much fewer, even for the general practitioner. Lastly, there is a groundswell conversation, at least in the endodontic community, that the benefits of the microscope are beyond biology. Clinicians experience a greater sense of personal and professional fulfillment because they are not achieving what is "good enough," but aspiring to "what is possible."

Dental Fistula↗
PubMedDate not supplied

Immediate implantation with provisionalization: from literature to clinical implications.

Numerous studies have confirmed the predictability of dental implants used for the replacement of a single missing tooth. Successful application of this surgical protocol is still technique sensitive and should be executed only by experienced restorative teams. Factors such as implant stability, implant design, immediate loading, provisionalization, and various others have a direct influence on the result of this procedure. This article reviews current literature on immediate implant placement and provides clinical guidelines aimed at improving the use of this technique in daily restorative practice.

Dental Abutments↗
PubMed2003

Evolving technology in endodontic posts.

This article provides a brief overview of important, recent changes in the philosophy, materials, and technology that have impacted significantly on the art and science of endodontic post placement.

Biocompatible Materials↗
PubMed2002

Vibration analysis of obturator prostheses with different bulb height designs.

The purpose of this study was to investigate the effect on the vibratory characteristics of a cast hollow obturator prosthesis retainer when varying its bulb height. Bulb parts with high (H), middle (M), and low (L) lateral walls were prepared. A Vibration Generator was used to excite the three obturators, while a Laser-Doppler Vibrometer was employed to detect the vibrations at specified measurement points. The frequency response functions of each obturator were recorded on an FFT analyzer to enable their modal shapes to be identified. In addition, transient response simulations were carried out and the decay rate (DR) and the maximum amplitude (MA) of the rest and clasp parts of each obturator were obtained. These were statistically analyzed by ANOVA and Fisher's PLSD test (p < 0.01). The modal shapes were almost the same in all obturators. Significant differences were found in DR in all pairs among the three obturator prostheses, with the DR of the L type being the highest. On the other hand, there were no significant differences in MA. We conclude that the L type is preferable from the standpoint of its vibratory characteristics.

Analysis of Variance↗
PubMedDate not supplied

Effect of intracrevicular restoration margins on peri-implant health: clinical, biochemical, and microbiologic findings around esthetic implants up to 9 years.

PURPOSE: The aim of the present study was to evaluate longitudinally the stability of a cohort of esthetic implants that had been in function for at least 1 year prior to the baseline examination. MATERIALS AND METHODS: Sixty-one maxillary anterior ITI implants in 45 systemically healthy patients, supporting single crown restorations, were randomly selected and examined. Clinical, microbiologic, and biochemical parameters were recorded at baseline and again after 3 years. Clinical examination included Plaque Index, Gingival Index, bleeding on probing, probing pocket depth (PPD), distance between implant shoulder and mucosal margin (DIM), and mobility. Dark-field microscopy and immunofluorescence were used to evaluate the bacteria morphotypes and the presence of 5 specific pathogenic bacteria, respectively. Peri-implant crevicular fluid (PICF) was collected at the mesial and distal sites of each implant, and total amounts of 3 biochemical markers were assessed: alkaline phosphatase was measured by using p-nitrophenyl-phosphate as substrate, elastase activity was measured by the use of a low-molecular-weight fluorogenic substrate, and the inhibitor alpha2-macroglobulin (alpha2M) was measured by enzyme-linked immunosorbent assay. RESULTS: The only statistically significant differences between baseline and follow-up examination concerned PPD and DIM measurements, which increased slightly. The remainder of the clinical measurements and almost all of the microbiologic and biochemical parameters did not change significantly. Furthermore, no associations were observed between the above results and the number of years that implants had been in function. DISCUSSION AND CONCLUSIONS: Based on an observation period of 4 to 9 years (mean 6.8 years at the time of the follow-up examination), it can be concluded that in patients with appropriate oral hygiene, the intracrevicular position of the restoration margin does not appear to adversely affect peri-implant health and stability.

Adult↗
PubMed2003

Ailing and failing endosseous dental implants: a literature review.

Although the overall success rate of implant dentistry is very high, dental implants occasionally fail. It is essential for the clinician to recognize unhealthy implants and to determine whether they are ailing, failing, or failed prior to beginning any salvage efforts. Ailing and failing implants are amenable to therapy. Implants diagnosed as failed should be removed. This review provides the reader with information on non-surgical and surgical therapies available for managing ailing and failing implants. Undoubtedly, the best steps to avoid encountering ailing or failing implants involve proper case selection, excellent surgical technique, placing an adequate restoration on the implant, educating the implant patient to maintain meticulous oral hygiene, and evaluating the implant both clinically and radiographically at frequent recall visits.

Anti-Infective Agents, Local↗
PubMed2003

[Implant survival and success rates in partially edentulous patients--Part I].

The use of osseointegrated implants is an accepted procedure for the treatment of complete or partially edentulous jaws. The purpose of this prospective long-term study was to evaluate the survival and success rates of endosseous dental implants (machined surface) in partially edentulous patients. A total of 76 patients (47 females, 29 males) with 214 implants (68 maxillary, 146 mandibulary) were evaluated. Their mean age was 45, ranging from 18 to 76 years. The implant length varied between 7 and 15 mm, the diameter between 3.4 and 6 mm. Nine implants were lost before abutment connection. Follow-up visits were scheduled at 3 and 6 months, 1 year, 2 and 3 years after insertion of the prostheses. Radiographic examination included intraoral periapical films to evaluate the horizontal and vertical bone loss. During the follow-up period, 18 implants in 10 patients were classified as failures. Fifteen implants were lost, and three implants were considered failures because of vertical bone loss greater than 0.2 mm per year after the first year of functional loading. The marginal bone loss averaged 2.1 mm in the maxillae and mandibles. According to the Kaplan-Meier estimator the probable implant survival and success is at 93% and 88% respectively after 63 months. Long implants (> 10 mm) have a significantly better chance of survival than shorter implants (< or = 10 mm). The results of this prospective study indicate that 3i endosseous dental implants provide an average foundation for implant-supported restorations.

Adolescent↗
PubMed2003

Primary stability and osseointegration: preliminary clinical results with a tapered diminishing-thread implant.

Due to their success and predictability, osseointegrated implants are used with increasing frequency for the prosthetic restoration of edentulous patients. Analysis of implant failures, however, enables clinicians to improve the clinical results achieved with this modality. While the literature discusses varying etiological factors (e.g., poor surgical technique, patient immune factors, insufficient bone quality or quantity), this article addresses primary stability as a predicator of implant success. The article also demonstrates the use of an anatomically shaped implant system that may improve primary stability in common clinical scenarios.

Bone Density↗
PubMed1992

The anterior single-tooth implant restoration.

Placing an anterior single-tooth implant requires thorough planning, informed abutment selection and precise surgical technique. Planning procedures are outlined; abutments, including UCLA's non-segmented, Nobelpharma's single-tooth, CeraOne and non-rotational, implant innovations' pre-angled and non-rotational and DIA's anatomic, are described, with indications and contraindications; and placement considerations are discussed.

Cuspid↗
PubMed1992

Precision attachment removable partial dentures.

Although added preparations and skill are required to provide precision attachment removable partial dentures, more favorable esthetics and load distribution may outweigh the disadvantages. Basic design principles, categories (intracoronal, extracoronal, stud, bar and plunger) and selection of precision attachments are reviewed.

Dental Prosthesis Retention↗